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Currently, doctors are unsure which is the best first-line treatment for patients with rare and advanced kidney cancers. During a debate at the 18th International Kidney Cancer Symposium (IKCS), 5 doctors discussed their opinions.
During the debate, the use of immunotherapy versus targeted kinase inhibitors (TKI) for the first-line treatment of advanced non-clear cell renal cell carcinoma (RCC) was discussed. Some doctors were proponents of cabozantinib, while others were advocates for immunotherapy, such as nivolumab and pembrolizumab.
During the debate, data from the CheckMate 374 study were presented. CheckMate 374 included 44 advanced non-clear cell RCC patients treated with nivolumab. Response rate was 13.6% and median overall survival (OS) was 16.3 months, although responses were regardless of PD-L1 expression. One patient with chromophobe RCC achieved a complete response and five others with papillary, unclassified, and other subtypes had partial responses.
To further support the argument for immunotherapy, data from the KEYNOTE-427 study were discussed. In this study, 165 patients with non-clear cell RCC were treated with pembrolizumab. Overall response rate of was 26% and disease control rate was 41%. At 11.1 months follow-up, median OS was not reached, and 72% patients were alive at 1 year. Response rates and disease control rates were higher for patients who were PD-L1- positive (35% and 49%, respectively).
On the side of cabozantinib, a multi-centre retrospective study reported a response rate of 27% (with one complete response in a papillary patient), a clinical benefit rate of 74%, and a median OS of 12 months, and “many of these patients had been previously treated with immunotherapy, TKI, or even both”.